Community-level risk: an ‘uninformative’ guide for Covid-19 prevention

For the first time since the Centers for Disease Control and Prevention introduced its three-level risk system in March 2022, on June 30 its community level map of Covid-19 cases had the dubious distinction of more counties classified as medium risk or high risk (55%) than those at low risk.

Official case counts are notoriously unreliable, given the widespread use of at-home Covid-19 tests, the results of which are not reported to county or state public health offices. And some people don’t bother to test themselves for Covid-19, especially those who don’t have symptoms.

The most worrisome aspect of the CDC map is that hospitalizations continue to climb, which is the primary driver that pushes counties into the medium- and high-risk community levels.

In spite of the pervasive belief that the Covid-19 pandemic is over, for people who have recently been hospitalized it may feel like it is just beginning. The challenge is deciding what people should be doing in this environment.

The pandemic has become one of individual choices rather than community action. Guidance from the CDC is far too blunt to be useful for individuals, so all persons are charged with the responsibility to decide what steps to take to protect themselves from infection and, in many cases, reinfection.

On one extreme are people who believe they need no protection and go about their affairs like it is 2019. On the other extreme are people striving to stay infection-free at all costs. They include individuals with health conditions that make them vulnerable to severe disease, or those who live with them, as well as people fearful of developing long Covid. This motivates them to stay away from crowded indoor venues like restaurants and wear high quality N95 and KF94 face masks when they are around others.

This is the “new normal” that many people have been waiting for. But it is bifurcating communities into two loosely defined groups of individuals.

Which group is justified? The data don’t provide an answer to that question.

The CDC says case counts are running at about 100,000 per day, but that is a gross underestimate. The true number of new infections and reinfections may be as much as 10 times higher, placing it on par with the Omicron surge in early 2022.

In contrast, the number of deaths has stayed remarkably steady, at around 300 per day. This is largely driven by more people being vaccinated, boosted, and, for some, double boosted. A possible Omicron-adapted vaccine could add even more protection. Treatments are also keeping people from the worst outcomes.

Though new hospital admissions have slowly but steadily crept up over the past several months, they continue to remain below previous peaks.

Focusing on deaths, Covid-19 has morphed into the equivalent of a harsh influenza season, with 60,000 to 80,000 deaths in the U.S. during a six-month period. Covid-19 is on track to cause around 100,000 deaths a year. Focusing on reported cases, Covid is now in line with the common cold.

The hospitalization rate provides the most informative measure of the status of the virus and its associated risks. Is having 10% or more of staffed inpatient beds occupied by patients with Covid-19, or having 10% or more of new Covid-19 admissions per 100,000 population, an adequate indicator for individuals to take appropriate actions to protect themselves against the disease?

Most Americans aren’t able to make such assessments, and so take action in light of their community risk level. This highlights how uninformative such community risk levels are for individuals, and why better communication is needed to help people protect themselves.

The recently concluded July 4 celebrations are certain to increase the number of medium- and high-level counties. With so many people acting like the pandemic is over, the next few months will indicate whether such beliefs are justified or misguided.

Sheldon H. Jacobson is a data scientist and professor of computer science at the University of Illinois Urbana-Champaign and the Carle Illinois College of Medicine.